BACKGROUND: One under-explored area in chronic obstructive pulmonary disease (COPD) patients is anxiety and/or depression, which may have negative impact in the patients' condition. This is possibly the first study to possibly assess the burden of anxiety and depression in COPD patients in the Philippines.

STUDY DESIGN: This is a prospective descriptive survey in three tertiary care hospitals in Manila, Philippines.

PARTICIPANTS: A total of 204 patients were enrolled in the study with the following inclusion criteria: Filipino patients who are aged more than or equal to 40 years with a diagnosis of COPD (documented post-bronchodilator FEV1/FVC ratio less than 0.7) by a physician seen at the outpatient clinics of three tertiary care hospitals with no primary diagnosis of asthma, no previous lung volume reduction surgery, lung transplantation or pneumonectomy and at least finished Grade 2 education.

Exclusion criteria include pregnant patients and patients previously diagnosed to have an anxiety, depression, or on any anti-depressant medications.

METHODS: Descriptive statistics was obtained with frequency and percentages of the demographic and physiologic variables in the study by tabulation and graph. The prevalence of anxiety and depression was determined by calculating the percentage of each patient with a score of 8 or higher on the Hospital Anxiety and Depression Scale (HADS) with validated Tagalog version, respectively.

RESULTS: The prevalence of anxiety in Filipino COPD patients is 47.55%. The prevalence of depression in Filipino COPD patients is 31.37%.

CONCLUSION: The prevalence of depression in Filipino COPD patients is comparable to the prevalence of depression from other general medical conditions nationwide according to the study of Batar (31.37% vs. 31%). Anxiety is slightly more prevalent in COPD from other general medical conditions (47.55% vs. 36%). A study on the risk factors of anxiety and depression among Filipino COPD patients is recommended.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Anxiety ; Depression ; Pulmonary Disease, Chronic Obstructive ; Patients ; Depression

COVID-19 ; Pneumonia

Objective: This single-subject case study was done to evaluate the presence and evaluate the risk factors for the development of Work-Related Musculoskeletal Disorders (WMSDs) among the staff performing bronchoscopy in the bronchoscopy suite. Methods: A single-subject case study to describe the ergonomic issues in bronchoscopy including identifying multiple factors that can potentially, either singly or in combination, affect physical work capacity. The study focused on the evaluation and control of occupational factors during bronchoscopy to improve awareness of ergonomic issues in bronchoscopy using the following data collection tools: 1) hierarchical task analysis, 2) activity sampling, 3) direct observation of the procedure (walk-around), 5) structured interview of the subject, and 5) utilization of checklists. Results: During the process of bronchoscopy, identified factors that can cause pain in the wrists, fingers, and shoulders include repetitive movement and awkward positions of the hands and wrists coming from the need to move the directional controls and position the bronchoscope. For the back, prolonged standing with awkward postures is a concern. For the neck, the need to look at the monitor which is situated at the side of the patient and frequent shifting of the eyes and head from the monitor to the patient can cause neck pain and stiffness. Aside from the above, other factors would include job stress from the workload, inadequate time for rest and recovery, and the possibility of an uncomfortable environment due to poor air quality. Chronic exposure and repeated injury followed by inflammation and repair lead to structural and biochemical changes in the tissues affected by Cumulative Trauma Disorders (CTDs) leading to the development of WMSDs. Conclusion Although CTDs do not account for work-related deaths, they do account for a significant amount of human suffering, loss of productivity, and economic burden on the compensation system. Thus, ergonomic concerns must be addressed early to prevent WMSDs/CTDs.
Bronchoscopy ; Occupational Health

Objective: The study aimed to investigate the relationship between cardiac Troponin I (cTnI) level and prognosis among mechanically ventilated patients in terms of mortality, prolonged mechanical ventilation, and tracheostomy rate. Methods: This is a prospective cohort study conducted at Quirino Memorial Medical Center, a tertiary government hospital, over a period of ten (10) months. Seventy-six (76) mechanically ventilated adult patients admitted at the medical intensive care unit, surgical intensive care unit, medical wards, and centers for neurologic sciences were included in the study. Quantitative cardiac Troponin I (cTnI) marker was measured and correlated to prognostic outcomes: a) prolonged ventilation (requiring more than 21 days), b) tracheostomy rate, and c) mortality rate. Data were analyzed using SPSS 16.0 and logistics regression with 95% confidence interval. Results: Results showed that among 76 patients, 15 patients have low cTnI levels, 11 patients have normal levels and 50 patients have elevated levels. Among patients with low cTnI levels (<0.020 ng/mL), 13 (86.7%) were extubated, 1 (6.7%) preceded tracheostomy and 1 (6.7%) expired. Those with normal range cTnI levels (0.020 – 0.060 ng/mL), 10 (90.9%) were extubated, none (0%) preceded tracheostomy and 1 (9.1%) expired. Those with elevated cTnI levels (>0.060 ng/mL), 7 (14.0%) were extubated, 7 (14.0%) preceded tracheostomy and 36 (72.0%) expired. Conclusion Analysis of the results showed a significant correlation of cTnI elevation with prognostic outcome proven by the p-value of < 0.0001. The risk of mortality among subjects with above normal cTnI levels were nine times (9x) higher compared to subjects with normal or low cTnI levels. Duration of intubation among patients with low normal and high cTnI levels did not differ significantly. Tracheostomy rate in the study was inconclusive.
Respiration, Artificial ; Mortality ; Prognosis

Objective: This single-subject case study was done to evaluate the presence and evaluate the risk factors for the development of Work-Related Musculoskeletal Disorders (WMSDs) among the staff performing bronchoscopy in the bronchoscopy suite. Methods: A single-subject case study to describe the ergonomic issues in bronchoscopy including identifying multiple factors that can potentially, either singly or in combination, affect physical work capacity. The study focused on the evaluation and control of occupational factors during bronchoscopy to improve awareness of ergonomic issues in bronchoscopy using the following data collection tools: 1) hierarchical task analysis, 2) activity sampling, 3) direct observation of the procedure (walk-around), 5) structured interview of the subject, and 5) utilization of checklists. Results: During the process of bronchoscopy, identified factors that can cause pain in the wrists, fingers, and shoulders include repetitive movement and awkward positions of the hands and wrists coming from the need to move the directional controls and position the bronchoscope. For the back, prolonged standing with awkward postures is a concern. For the neck, the need to look at the monitor which is situated at the side of the patient and frequent shifting of the eyes and head from the monitor to the patient can cause neck pain and stiffness. Aside from the above, other factors would include job stress from the workload, inadequate time for rest and recovery, and the possibility of an uncomfortable environment due to poor air quality. Chronic exposure and repeated injury followed by inflammation and repair lead to structural and biochemical changes in the tissues affected by Cumulative Trauma Disorders (CTDs) leading to the development of WMSDs. Conclusion Although CTDs do not account for work-related deaths, they do account for a significant amount of human suffering, loss of productivity, and economic burden on the compensation system. Thus, ergonomic concerns must be addressed early to prevent WMSDs/CTDs.
Bronchoscopy ; occupational health

Objective: The study aimed to investigate the relationship between cardiac Troponin I (cTnI) level and prognosis among mechanically ventilated patients in terms of mortality, prolonged mechanical ventilation, and tracheostomy rate. Methods: This is a prospective cohort study conducted at Quirino Memorial Medical Center, a tertiary government hospital, over a period of ten (10) months. Seventy-six (76) mechanically ventilated adult patients admitted at the medical intensive care unit, surgical intensive care unit, medical wards, and centers for neurologic sciences were included in the study. Quantitative cardiac Troponin I (cTnI) marker was measured and correlated to prognostic outcomes: a) prolonged ventilation (requiring more than 21 days), b) tracheostomy rate, and c) mortality rate. Data were analyzed using SPSS 16.0 and logistics regression with 95% confidence interval. Results: Results showed that among 76 patients, 15 patients have low cTnI levels, 11 patients have normal levels and 50 patients have elevated levels. Among patients with low cTnI levels (<0.020 ng/mL), 13 (86.7%) were extubated, 1 (6.7%) preceded tracheostomy and 1 (6.7%) expired. Those with normal range cTnI levels (0.020 – 0.060 ng/ mL), 10 (90.9%) were extubated, none (0%) preceded tracheostomy and 1 (9.1%) expired. Those with elevated cTnI levels (>0.060 ng/mL), 7 (14.0%) were extubated, 7 (14.0%) preceded tracheostomy and 36 (72.0%) expired. Conclusion Analysis of the results showed a significant correlation of cTnI elevation with prognostic outcome proven by the p-value of < 0.0001. The risk of mortality among subjects with above normal cTnI levels were nine times (9x) higher compared to subjects with normal or low cTnI levels. Duration of intubation among patients with low normal and high cTnI levels did not differ significantly. Tracheostomy rate in the study was inconclusive.
Respiration, Artificial ; Mortality ; Prognosis

A 60-year-old Filipino woman diagnosed with dermatomyositis was initially on prednisone and methotrexate. She eventually developed interstitial lung disease (ILD) and so methotrexate was shifted to azathioprine; however, azathioprine was discontinued due to cutaneous tuberculosis. Over eight years, the dermatomyositis was controlled by prednisone alone but the ILD worsened. This case demonstrated that the course of ILD may be independent of dermatomyositis.
dermatomyositis ; interstitial lung disease ; immunomodulator

Objective: This study aims to validate a Filipino version of the questionnaire by Delclos et al on occupational risk factors and asthma among the health care workers of the Philippine General Hospital. Methodology: Forward and backward translation method for bilinguals was used in this study. The Filipino translation was administered to 110 health care workers selected by stratified random sampling. After 24 hours, the retranslated English version was given to the same respondents. Testing for internal consistency reliability was done by computing for Cronbach's alpha. Construct validity was subsequently determined using the Cramer's V Coefficient. Results: The Filipino questionnaire showed good internal consistency reliability, as shown by the overall Cronbach’s alpha of 0.9016, which is comparable to that of the original version by Delclos. Likewise, our Filipino questionnaire showed good construct validity, supported by the Cramer’s V coefficients ranging from 0.2204 (strong relationship) to 0.7843 (very strong relationship). Conclusion Overall, the Filipino version of the questionnaire for work-related asthma tested among the health care workers of Philippine General Hospital showed good reliability and validity. This may now be used as screening tool for occupational asthma among health care workers who are at risk of developing the disease. In addition, this research tool may be utilized to establish the prevalence of occupational asthma in hospitals and later on, aid in the development of a better working environment for the whole health care team.
Health Personnel ; Surveys and Questionnaires